Provider Demographics
NPI:1164820122
Name:NADERPLC
Entity Type:Organization
Organization Name:NADERPLC
Other - Org Name:ASHBURN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKKHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-459-5231
Mailing Address - Street 1:44365 PREMIER PLZ
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5057
Mailing Address - Country:US
Mailing Address - Phone:703-726-7508
Mailing Address - Fax:703-935-8018
Practice Address - Street 1:44014 CHELTENHAM CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4900
Practice Address - Country:US
Practice Address - Phone:703-459-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty